Ob-Gyn NBME Form 2 - Questions and Answers 37 yo - G8P8 - inc vag bleeding over last 5 hrs abd exam: gucci bimanual/rectal exams: 8 cm mass of upper cervix and R.parametrium no ovary palpated separately CT: R.hydroureter above level of mass most likely dx? squamous cell carcinoma of the cervix ma...
Ob-Gyn NBME Form 2 37 yo - G8P8 - inc vag bleeding over last 5 hrs abd exam: gucci bimanual/rectal exams: 8 cm mass of upper cervix and R.parametrium no ovary palpated separately CT: R.hydroureter above level of mass most likely dx? squamous cell carcinoma of the cervix mass is clearly big and has spread due to ability to palpate mass and hydroureter present involvement of bowel/bladder (a) or distant mets (b) > stage 4 tx: surgery or chemo parametrium = fibrous/fatty CT that surrounds uterus 17 yo primigravid - 34 wks gest missed last appointment 2 wks ago good fetal movement; no contractions, vag bleeding, or loss of vag fluid smokes 2 packs of cigs qd for 3 yrs; smoking throughout pregnancy no alcohol, illicit drugs gained 10 lb during preg BP: 100/55 mmHg PE: fundal height 30 cm fetal HR: 150/min next step in dx? nonstress test done in high risk pt or dec fetal movement pt is high risk bc 6 pack yr hx and still is smoking for high risk pt - should do NST qWeek until delivery remember you want: 15, 15, 2 in 20 (>32 wks); 10, 10, 2 in 20 (<32 wks) 25 yo nulligravid - no period for 1 yr menarche at 13 menses initially were reg 2 yrs ago: menses irregular (45 -90 day intervals) > amenorrheic no PMHx; no meds no cigs, alcohol, illicit drugs runs 7 m iles qd; 3 marathons past yr no sex active BMI: 17 PE: gucci measurement of serum hormone conc will show what? dec estrogen and FSH conc dx of exclusion anorexia or extreme weight loss/exercise low BMI > dec stimulation of hypothalamic -pit axis dec FSH > d ec estrogen 24 yo primigravid African American - 11 wks gest meds: prenatal vitamins PE: no peripheral edema fetal HR: 150/min first prenatal visit 4 wks ago: Hgb dec; MCH dec; MCV dec; WBC barely WNL (10,900); plts dec; HgbA 95% UA: no protein, ketones, glucose most likely cause of lab findings? Fe def MCV and MCH dec - MC cause Fe def I'm assuming if it was physiological dilution of pregnancy - the MCV and MCH wouldn't change; just the Hgb (RBC inc/plasma volume inc inc) 22 yo - bump on vulva for 1 wk sex active w/ 1 partner for 2 yr; oral contraceptive PE: multiple 0.25 cm raised, crusty papule on post fourchette Pap smear: low -grade squamous intraepi lesions most likely dx? condylomata acuminata acuminata: HPV types 6 and 11; smooth papules or sessil e, verrucous growths Pap smear was irregular so suggests HPV infection tx: chemical - podophyllin resin, trichloroacetic acid; immuno - imiquimod; surgical - cryotherapy, laser therapy, excision prevention: vaccination; barrier contraception 32 yo - G3P2 - 4111 g (9lb 1 oz) newborn at term 2 hr second stage of labor assisted by medial episiotomy placenta delivers 12 min later using gentle umbilical cord traction firm pale mass noted in lower vag; mod vag bleeding pt develops SOB P: 60/min BP: 60/40 mmHg abd exam: uterus can't be palpated tx: IV saline - doesn't improve symptoms most likely dx? uterine inversion "uterus is absent" caused by defect in myometrium dx: speculum exam tx: tack fornices in place; tocolytics to calm down uterus; give oxytocin to contract uterus back into position 5 yo girl - dad noticed blood on her underpants rubbing/scratching her genital area for last 5 days irritation persisted despite topical vit A/D and warm baths foul-smelling discharge and burning/itching in area (worse w/ urination) runny nose during period no fever; no PMHx PE: green vag discharge; diffuse inflammation of vulva; hymen intact; no lacerations, ecchymoses, or other signs of trauma wet mount of discharge: occasio nal erythrocytes and numerous leukocytes culture: polymicrobial infection most likely cause? vaginal foreign body symptoms include: dysuria, enuresis, frequent UTIs, genital irritation/itching, vag/penile discharge, vag bleeding, genital/anal pain, abd pai n, and encopresis 16 yo - never had period Tanner stage 3 - breast no ax or pubic hair pelvic exam: vag 2 cm pelvic US: no uterus most likely dx? androgen insensitivity syndrome insensitivity to testosterone by the body has testes - phenotypically female though tx: elevate the vagina 32 yo nulligravid - PMHx: bipolar - valproic acid PE: gucci MSE: affect full; no pressured speech or flight of ideas future child is at the greatest risk for what if she continues to take valproic acid throughout pregnancy? neural tube defects inc in NTDs in pts taking valproic acid and carbamazepine should take extra folate
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